Application for Cdl Employment

APPLICATION FOR CDL EMPLOYMENT

(An equal opportunity Employer)

Date:

NAME:

Last First Middle

phone number: Social Security: D.O.B:

Present

Address:

Street City State Zip Code

Previous (if less than 3 years)

Address:

Street city state zip code

CDL License:

State number expiration date

education / name and location of school / years attended / did you graduate / subjects studied
high school
college
trade, business or correspondence school

Driver experience

yes no years

class ‘a’

class ‘b’

class ‘c’

list endorsements:

loader

excavator

backhoe

farm tractor

accident history – for previous 3 years

date of accident / nature of accident / fatalities or personal injuries

motor vehicle violations – other than parking for pervious 3 years

date of conviction / offense (be specific)

Has your license ever been suspended, revoked, or denied? Yes no (circle one)

if yes, please explain:

employment history (list all employers in the last 3 years preceding the date of application)

date, month, year / name and address of employer / salary / position / reason for leaving
were you subject to fmcsr while employed? / was job designated as a safety sensitive function and subject to dot alcohol and drug testing?
date, month, year / name and address of employer / salary / position / reason for leaving
were you subject to fmcsr while employed? / was job designated as a safety sensitive function and subject to dot alcohol and drug testing?
date, month, year / name and address of employer / salary / position / reason for leaving
were you subject to fmcsr while employed? / was job designated as a safety sensitive function and subject to dot alcohol and drug testing?

List the names and addresses of employers for the 7 years preceding the 3 years listed above in which you were the operator of a commercial motor vehicle

employer address date of employment reason for leaving

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if i am employed, my employment may be terminated at any time.

in consideration of my employment, i agree to conform the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. i also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. i understand that no company representative, other than it’s president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

i acknowledge that any employment offers will be contingent on passing a pre-employment drug screening.

signature of applicant

print name

The Name of Municipality is an equal opportunity employer. It is the policy of this municipality to provide equal employment opportunity to all applicants and employees without regard to race, color, religion, national origin, sex, sexual orientation, ancestry, place of birth, age, disability, HIV status, or other status protected by state or federal law. No question is asked on this application or during the application process for the purpose of excluding any applicant due to race, color, religion, national origin, sex, sexual orientation, ancestry, place of birth, age, disability, HIV status, or other status under federal or state law.

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

**This form has been designed to strictly comply with state and federal fair employment practice laws prohibiting employment discrimination.

CDL Employment Application 4